Antibiotic Prescribing Patterns and Their Association with Resistance Trends in Community-Acquired Infections: A Retrospective Data Analysis
Department of Basic Sciences, College of Dentistry, University of Alkafeel, Najaf, Iraq.
Research Article
Open Access Research Journal of Biology and Pharmacy, 2025, 15(01), 055-062.
Article DOI: 10.53022/oarjbp.2025.15.1.0046
Publication history:
Received on 18 September 2025; revised on 25 October 2025; accepted on 27 October 2025
Abstract:
Background: Community-acquired infections (CAIs) are a major cause of morbidity and typically require empirical therapy. The growing problem of antimicrobial resistance (AMR), which is a major threat to successful treatment, results in part from overuse and misuse of antibiotics. In countries like Iraq as well as many low- and middle-income countries, high rates of prescribing and poor diagnostic capacity worsen resistance patterns.
Objectives: To describe antibiotic prescribing practices for Community-acquired infections (CAIs) in Najaf (2022–2024), and to determine their correlation with resistance dynamics among frequent community pathogens.
Methods: A retrospective observational study was conducted involving 1,214 Community-acquired infections (CAI) cases in community health centers. Prescription rates, antibiotic class and antimicrobial activity data were recorded. Antibiotic prescribing was evaluated according to indication, season and antibiotic class. Escherichia coli, Staphylococcus aureus and Streptococcus pneumonia were investigated with respect to resistance rates. Time-series correlations were conducted to examine relationships between prescribing patterns and resistance development.
Results: Respiratory tract infection (RTI) was the most common Community-acquired infections (48.2%) followed by urinary tract infection (32.5%) and skin and soft tissue infection (19.3%). Empiric prescription was prescribed in 62.7% and culture-guided therapy in 37.3%. The most commonly prescribed class of antibiotics were β-lactam/β-lactamase inhibitors (32.6%), followed by cephalosporins (27.4%) and fluoroquinolones (18.1%). Seasonal prescribing peaks were seen in the winter (+ 27% vs summer). Resistance significantly increased between 2022 and 2024 among E. coli (ciprofloxacin:28%→39%, cephalosporins:32%→48%) and S. pneumoniae (amoxicillin–clavulanate:35%→44%), with methicillin resistant staphylococcus aureus (MRSA) prevalence also increasing from 11% to 18% (p = <0.05). Fluoroquinolone prescribing was strongly associated with E. coli ciprofloxacin resistance (r = 0.72, lag 4–6 months), cephalosporin use was correlated with Extended-Spectrum Beta-Lactamase (ESBL) K. pneumoniae prevalence (r = 0.68) and seasonal azithromycin prescribing preceded higher macrolide resistance in S. pneumoniae by one season.
Conclusions: Antibiotic prescribing in Najaf could be described with high dependency on broad-spectrum empirical therapy, which is significantly correlated to antimicrobial resistance (AMR) trends. Emerging resistance in Escherichia coli, Streptococcus pneumoniae, and methicillin resistant staphylococcus aureus (MRSA) underscores the pressing requirement for population-level antibiotic stewardship efforts, improved diagnostic capabilities, and intervention targets designed to optimize prescribing practices—most notably with regard to fluoroquinolones, cephalosporins, and macrolides.
Keywords:
Community-Acquired Infections; Antibiotic Prescriptions; Antimicrobial Resistance; Time-Series Analysis; Iraq; Stewardship
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